Healthcare Provider Details

I. General information

NPI: 1376849646
Provider Name (Legal Business Name): JOANNE E CIMORELLI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WALL ST
AMSTERDAM NY
12010-4309
US

IV. Provider business mailing address

504 AVALON PL
COHOES NY
12047-1763
US

V. Phone/Fax

Practice location:
  • Phone: 518-843-2575
  • Fax: 518-842-9592
Mailing address:
  • Phone: 518-326-2993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number011244
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: